Doctors are in fact the LEADING cause of death in this country.
In all fairness, doctors
themselves are not to blame for all of this. The entire modern health
care system, however, is to blame for allowing, even promoting,
so many unnecessary procedures, drugs and mishaps. This illustrates
precisely why the system is so desperately in need of change.

A definitive review and close reading of medical peer-review journals,
and government health statistics shows that American medicine frequently
causes more harm than good. The number of people having in-hospital,
adverse drug reactions (ADR) to prescribed medicine is 2.2 million.
1 Dr. Richard Besser, of the CDC, in 1995, said the number
of unnecessary antibiotics prescribed annually for viral infections
was 20 million. Dr. Besser, in 2003, now refers to tens of millions
of unnecessary antibiotics. 2, 2a

The number of unnecessary medical and surgical procedures performed
annually is 7.5 million. 3 The number of people exposed
to unnecessary hospitalization annually is 8.9 million. 4
The total number of iatrogenic [induced inadvertently by a physician
or surgeon or by medical treatment or diagnostic procedures] deaths
shown in the following table is 783,936.

It is evident that the American medical system is the leading
cause of death and injury in the United States. The 2001 heart
disease annual death rate is 699,697; the annual cancer death rate,
553,251. 5

TABLES AND FIGURES (see Section on Statistical Tables and Figures,
below, for exposition)

ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION

Condition

Deaths

Cost

Author

Adverse Drug Reactions

106,000

$12 billion

Lazarou1
Suh49

Medical error

98,000

$2 billion

IOM6

Bedsores

115,000

$55 billion

Xakellis7
Barczak8

Infection

88,000

$5 billion

Weinstein9
MMWR10

Malnutrition

108,800

--------

Nurses Coalition11

Outpatients

199,000

$77 billion

Starfield12
Weingart112

Unnecessary Procedures

37,136

$122 billion

HCUP3,13

Surgery-Related

32,000

$9 billion

AHRQ85

TOTAL

783,936

$282 billion

We could have an even higher death rate by using Dr. Lucien
Leapes 1997 medical and drug error rate of 3 million. 14
Multiplied by the fatality rate of 14 percent (that Leape used in
1994 16 we arrive at an annual death rate of 420,000
for drug errors and medical errors combined. If we put this number
in place of Lazorous 106,000 drug errors and the Institute
of Medicines (IOM) 98,000 medical errors, we could add another
216,000 deaths making a total of 999,936 deaths annually.

Condition

Deaths

Cost

Author

ADR/med error

420,000

$200 billion

Leape 199714

TOTAL

999,936

ANNUAL UNNECESSARY MEDICAL EVENTS STATISTICS

Unnecessary Events

People Affected

Iatrogenic Events

Hospitalization

8.9 million4

1.78 million16

Procedures

7.5 million3

1.3 million40

TOTAL

16.4 million

3.08 million

The enumerating of unnecessary medical events is very important
in our analysis. Any medical procedure that is invasive and not
necessary must be considered as part of the larger iatrogenic picture.
Unfortunately, cause and effect go unmonitored. The figures on unnecessary
events represent people ("patients") who are thrust into
a dangerous health care system. They are helpless victims. Each
one of these 16.4 million lives is being affected in a way that
could have a fatal consequence. Simply entering a hospital could
result in the following (out of 16. 4 million people):

All the statistics above represent a one-year time span. Imagine
the numbers over a 10-year period. Working with the most conservative
figures from our statistics we project the following 10-year death
rates.

TEN-YEAR DEATH RATES FOR MEDICAL INTERVENTION

Condition

10-Year Deaths

Author

Adverse Drug Reaction

1.06 million

(1)

Medical error

0.98 million

(6)

Bedsores

1.15 million

(7,8)

Nosocomial Infection

0.88 million

(9,10)

Malnutrition

1.09 million

(11)

Outpatients

1.99 million

(12, 112)

Unnecessary Procedures

371,360

(3,13)

Surgery-related

320,000

(85)

TOTAL

7,841,360 (7.8 million)

Our projected statistic of 7.8 million iatrogenic deaths is more
than all the casualties from wars that America has fought in its
entire history.

Our projected figures for unnecessary medical events occurring
over a 10-year period are also dramatic.

TEN-YEAR STATISTICS FOR UNNECESSARY INTERVENTION

Unnecessary Events

10-year Number

Iatrogenic Events

Hospitalization

89 million4

17 million

Procedures

75 million3

15 million

TOTAL

164 million

These projected figures show that a total of 164 million people,
approximately 56 percent of the population of the United States,
have been treated unnecessarily by the medical industry--in other
words, nearly 50,000 people per day.

Introduction

Never before have the complete statistics on the multiple causes
of iatrogenesis been combined in one paper. Medical science amasses
tens of thousands of papers annually--each one a tiny fragment of
the whole picture.

To look at only one piece and try to understand the benefits and
risks is to stand one inch away from an elephant and describe everything
about it.

You have to pull back to reveal the complete picture, such as we
have done here. Each specialty, each division of medicine, keeps
their own records and data on morbidity and mortality like pieces
of a puzzle. But the numbers and statistics were always hiding in
plain sight. We have now completed the painstaking work of reviewing
thousands and thousands of studies. Finally putting the puzzle together
we came up with some disturbing answers.

Is American Medicine Working?

At 14 percent of the Gross National Product, health care spending
reached $1.6 trillion in 2003.15 Considering this enormous
expenditure, we should have the best medicine in the world. We should
be reversing disease, preventing disease, and doing minimal harm.
However, careful and objective review shows the opposite. Because
of the extraordinary narrow context of medical technology through
which contemporary medicine examines the human condition, we are
completely missing the full picture.

Medicine is not taking into consideration the following monumentally
important aspects of a healthy human organism:

(a) Stress and how it adversely affects the immune system and
life processes

Instead of minimizing these disease-causing factors, we actually
cause more illness through medical technology, diagnostic testing,
overuse of medical and surgical procedures, and overuse of pharmaceutical
drugs. The huge disservice of this therapeutic strategy is the result
of little effort or money being appropriated for preventing disease.

Under-reporting of Iatrogenic Events

As few as 5 percent and only up to 20 percent of iatrogenic acts
are ever reported.16,24,25,33,34 This implies that if
medical errors were completely and accurately reported, we would
have a much higher annual iatrogenic death rate than 783,936. Dr.
Leape, in 1994, said his figure of 180,000 medical mistakes annually
was equivalent to three jumbo-jet crashes every two days.16
Our report shows that six jumbo jets are falling out of the sky
each and every day.

Correcting a Compromised System

What we must deduce from this report is that medicine is in need
of complete and total reform: from the curriculum in medical schools
to protecting patients from excessive medical intervention. It is
quite obvious that we cant change anything if we are not honest
about what needs to be changed. This report simply shows the degree
to which change is required.

We are fully aware that what stands in the way of change are powerful
pharmaceutical companies, medical technology companies, and special
interest groups with enormous vested interests in the business of
medicine. They fund medical research, support medical schools and
hospitals, and advertise in medical journals. With deep pockets
they entice scientists and academics to support their efforts. Such
funding can sway the balance of opinion from professional caution
to uncritical acceptance of a new therapy or drug.

You only have to look at the number of invested people on hospital,
medical, and government health advisory boards to see conflict of
interest. The public is mostly unaware of these interlocking interests.
For example, a 2003 study found that nearly half of medical school
faculty, who serve on Institutional Review Boards (IRB) to advise
on clinical trial research, also serve as consultants to the pharmaceutical
industry. 17 The authors were concerned that such representation
could cause potential conflicts of interest.

A news release by Dr. Erik Campbell, the lead author, said,

"Our previous research with faculty has shown us that ties
to industry can affect scientific behavior, leading to such things
as trade secrecy and delays in publishing research. It's possible
that similar relationships with companies could affect IRB members'
activities and attitudes."18

Medical Ethics and Conflict of Interest
in Scientific Medicine

Jonathan Quick, director of Essential Drugs and Medicines Policy
for the World Health Organization (WHO) wrote in a recent WHO Bulletin:

"If clinical trials become a commercial venture in which
self-interest overrules public interest and desire overrules science,
then the social contract which allows research on human subjects
in return for medical advances is broken."19

Former editor of the New England Journal of Medicine (NEJM), Dr.
Marcia Angell, struggled to bring the attention of the world to
the problem of commercializing scientific research in her outgoing
editorial titled "Is Academic Medicine for Sale?"20
Angell called for stronger restrictions on pharmaceutical stock
ownership and other financial incentives for researchers. She said
that growing conflicts of interest are tainting science.

She warned that, "When the boundaries between industry and
academic medicine become as blurred as they are now, the business
goals of industry influence the mission of medical schools in multiple
ways." She did not discount the benefits of research but said
a Faustian bargain now existed between medical schools and the pharmaceutical
industry.

Angell left the NEMJ in June 2000. Two years later, in June
2002, the NEJM announced that it would now accept biased journalists
(those who accept money from drug companies) because it is too difficult
to find ones who have no ties. Another former editor of the journal,
Dr. Jerome Kassirer, said that was just not the case, that there
are plenty of researchers who dont work for drug companies.21
The ABC report said that one measurable tie between pharmaceutical
companies and doctors amounts to over $2 billion a year spent for
over 314,000 events that doctors attend.

The ABC report also noted that a survey of clinical trials revealed
that when a drug company funds a study, there is a 90 percent chance
that the drug will be perceived as effective whereas a non-drug
company-funded study will show favorable results 50 percent of the
time.

It appears that money cant buy you love but it can buy
you any "scientific" result you want.

The only safeguard to reporting these studies was if the journal
writers remained unbiased. That is no longer the case.

Cynthia Crossen, writer for the Wall Street Journal in 1996, published
"Tainted Truth: The Manipulation of Fact in America,"
a book about the widespread practice of lying with statistics.22
Commenting on the state of scientific research she said that:

"The road to hell was paved with the flood of corporate
research dollars that eagerly filled gaps left by slashed government
research funding."

Her data on financial involvement showed that in l981 the drug
industry "gave" $292 million to colleges and universities
for research. In l991 it "gave" $2.1 billion.

The First Iatrogenic Study

Dr. Lucian L. Leape opened medicines Pandoras box in
his 1994 JAMA paper, "Error in Medicine."16
He began the paper by reminiscing about Florence Nightingales
maxim--"first do no harm." But he found evidence of the
opposite happening in medicine. He found that Schimmel reported
in 1964 that 20 percent of hospital patients suffered iatrogenic
injury, with a 20 percent fatality rate. Steel in 1981 reported
that 36 percent of hospitalized patients experienced iatrogenesis
with a 25 percent fatality rate and adverse drug reactions were
involved in 50 percent of the injuries. Bedell in 1991 reported
that 64 percent of acute heart attacks in one hospital were preventable
and were mostly due to adverse drug reactions.

However, Leape focused on his and Brennans "Harvard
Medical Practice Study" published in 1991.16a They
found that in 1984, in New York State, there was a 4 percent iatrogenic
injury rate for patients with a 14 percent fatality rate. From the
98,609 patients injured and the 14 percent fatality rate, he estimated
that in the whole of the United States 180,000 people die each year,
partly as a result of iatrogenic injury. Leape compared these deaths
to the equivalent of three jumbo-jet crashes every two days.

Why Leape chose to use the much lower figure of four percent injury
for his analysis remains in question. Perhaps he wanted to tread
lightly. If Leape had, instead, calculated the average rate among
the three studies he cites (36 percent, 20 percent, and 4 percent),
he would have come up with a 20 percent medical error rate. The
number of fatalities that he could have presented, using an average
rate of injury and his 14 percent fatality, is an annual 1,189,576
iatrogenic deaths, or over ten jumbo jets crashing every day.

Leape acknowledged that the literature on medical error is sparse
and we are only seeing the tip of the iceberg. He said that
when errors are specifically sought out, reported rates are "distressingly
high." He cited several autopsy studies with rates as high
as 35 percent to 40 percent of missed diagnoses causing death.
He also commented that an intensive care unit reported an average
of 1.7 errors per day per patient, and 29 percent of those errors
were potentially serious or fatal.

We wonder: what is the effect on someone who daily gets the wrong
medication, the wrong dose, the wrong procedure; how do we measure
the accumulated burden of injury; and when the patient finally succumbs
after the tenth error that week, what is entered on the death certificate?

Leape calculated the rate of error in the intensive care unit.
First, he found that each patient had an average of 178 "activities"
(staff/procedure/medical interactions) a day, of which 1.7 were
errors, which means a 1 percent failure rate. To some this may not
seem like much, but putting this into perspective, Leape cited industry
standards where in aviation a 0.1 percent failure rate would mean:

Two unsafe plane landings per day at OHare airport

In the U.S. mail, 16,000 pieces of lost mail every hour

In banking, 32,000 bank checks deducted from the wrong bank
account every hour

Analyzing why there is so much medical error Leape acknowledged
the lack of reporting. Unlike a jumbo-jet crash, which gets instant
media coverage, hospital errors are spread out over the country
in thousands of different locations. They are also perceived as
isolated and unusual events. However, the most important reason
that medical error is unrecognized and growing, according to Leape,
was, and still is, that doctors and nurses are unequipped to deal
with human error, due to the culture of medical training and practice.

Doctors are taught that mistakes are unacceptable. Medical mistakes
are therefore viewed as a failure of character and any error equals
negligence.

We can see how a great deal of sweeping under the rug takes place
since nobody is taught what to do when medical error does occur.
Leape cited McIntyre and Popper who said the "infallibility
model" of medicine leads to intellectual dishonesty with a
need to cover up mistakes rather than admit them. There are no Grand
Rounds on medical errors, no sharing of failures among doctors and
no one to support them emotionally when their error harms a patient.

Leape hoped his paper would encourage medicine "to fundamentally
change the way they think about errors and why they occur."
Its been almost a decade since this groundbreaking work, but
the mistakes continue to soar.

One year later, in 1995, a report in JAMA said that:

"Over a million patients are injured in U.S. hospitals each
year, and approximately 280,000 die annually as a result of these
injuries. Therefore, the iatrogenic death rate dwarfs the annual
automobile accident mortality rate of 45,000 and accounts for
more deaths than all other accidents combined."23

At a press conference in 1997 Dr. Leape released a nationwide poll
on patient iatrogenesis conducted by the National Patient Safety
Foundation (NPSF), which is sponsored by the American Medical Association.
The survey found that more than 100 million Americans have been
impacted directly and indirectly by a medical mistake. Forty-two
percent were directly affected and a total of 84 percent personally
knew of someone who had experienced a medical mistake.14
Dr. Leape is a founding member of the NPSF.

Dr. Leape at this press conference also updated his 1994 statistics
saying that medical errors in inpatient hospital settings nationwide,
as of 1997, could be as high as 3 million and could cost as much
as $200 billion. Leape used a 14 percent fatality rate to determine
a medical error death rate of 180,000 in 1994.16 In 1997, using
Leapes base number of 3 million errors, the annual deaths
could be as much as 420,000 for inpatients alone. This does not
include nursing home deaths, or people in the outpatient community
dying of drug side effects or as the result of medical procedures.

Only a Fraction of Medical Errors are
Reported

Leape, in 1994, said that he was well aware that medical errors
were not being reported.16 According to a study in two obstetrical
units in the U.K., only about one quarter of the adverse incidents
on the units are ever reported for reasons of protecting staff or
preserving reputations, or fear of reprisals, including law suits.24
An analysis by Wald and Shojania found that only 1.5 percent
of all adverse events result in an incident report, and only
6 percent of adverse drug events are identified properly.

The authors learned that the American College of Surgeons gives
a very broad guess that surgical incident reports routinely capture
only 5 percent to 30 percent of adverse events. In one surgical
study only 20 percent of surgical complications resulted in discussion
at Morbidity and Mortality Rounds.25 From these studies
it appears that all the statistics that are gathered may be substantially
underestimating the number of adverse drug and medical therapy incidents.
It also underscores the fact that our mortality statistics are actually
conservative figures.

An article in Psychiatric Times outlines the stakes involved with
reporting medical errors.26 They found that the public
is fearful of suffering a fatal medical error, and doctors are afraid
they will be sued if they report an error.

This brings up the obvious question: who is reporting medical errors?

Usually it is the patient or the patients surviving family.
If no one notices the error, it is never reported. Janet Heinrich,
an associate director at the U.S. General Accounting Office responsible
for health financing and public health issues, testifying before
a House subcommittee about medical errors, said that:

"The full magnitude of their threat to the American public
is unknown." She added, "Gathering valid and useful
information about adverse events is extremely difficult."

She acknowledged that the fear of being blamed, and the potential
for legal liability, played key roles in the under-reporting of
errors. The Psychiatric Times noted that the American Medical Association
is strongly opposed to mandatory reporting of medical errors.26
If doctors arent reporting, what about nurses? In a survey
of nurses, they also did not report medical mistakes for fear of
retaliation.27

Standard medical pharmacology texts admit that relatively few doctors
ever report adverse drug reactions to the FDA.28 The
reasons range from not knowing such a reporting system exists to
fear of being sued because they prescribed a drug that caused harm.
29 However, it is this tremendously flawed system of
voluntary reporting from doctors that we depend on to know whether
a drug or a medical intervention is harmful.

Pharmacology texts will also tell doctors how hard it is to separate
drug side effects from disease symptoms. Treatment failure is most
often attributed to the disease and not the drug or the doctor.
Doctors are warned, "Probably nowhere else in professional
life are mistakes so easily hidden, even from ourselves."30
It may be hard to accept, but not difficult to understand, why only
one in twenty side effects is reported to either hospital administrators
or the FDA.31,31a

If hospitals admitted to the actual number of errors and mistakes,
which is about 20 times what is reported, they would come under
intense scrutiny.32

Jerry Phillips, associate director of the Office of Post Marketing
Drug Risk Assessment at the FDA, confirms this number. "In
the broader area of adverse drug reaction data, the 250,000 reports
received annually probably represent only 5 percent of the actual
reactions that occur."33 Dr. Jay Cohen, who has
extensively researched adverse drug reactions, comments that because
only 5 percent of adverse drug reactions are being reported, there
are, in reality, 5 million medication reactions each year.34

It remains that whatever figure you choose to believe about the
side effects from drugs, all the experts agree that you have to
multiply that by 20 to get a more accurate estimate of what is really
occurring in the burgeoning "field" of iatrogenic medicine.

A 2003 survey is all the more distressing because there seems to
be no improvement in error reporting even with all the attention
on this topic. Dr. Dorothea Wild surveyed medical residents at a
community hospital in Connecticut. She found that only half of the
residents were aware that the hospital had a medical error-reporting
system, and the vast majority didnt use it at all. Dr. Wild
says this does not bode well for the future. If doctors dont
learn error reporting in their training, they will never use it.
And she adds that error reporting is the first step in finding out
where the gaps in the medical system are and fixing them. That first
baby step has not even begun.35

Public Suggestions on Iatrogenesis

In a telephone survey, 1,207 adults were asked to indicate how
effective they thought the following would be in reducing preventable
medical errors that resulted in serious harm:36

Giving doctors more time to spend with patients: very effective
78 percent

Requiring hospitals to report all serious medical errors to
a state agency: very effective 71 percent

Increasing the number of hospital nurses: very effective 69
percent

Reducing the work hours of doctors-in-training to avoid fatigue:
very effective 66 percent

Encouraging hospitals to voluntarily report serious medical
errors to a state agency: very effective 62 percent

Source: http://www.mercola.com/2004/jul/7/healthcare_death.htm

“Death by Modern Medicine” identifies the tragic aspects of a medical system that in its short history of about eighty years, has managed to kill tens of millions of victims. It goes beyond the statistics of deaths due to drugs. It shows how the medical monopoly that created the system in the first place, is allowed to control health care, propaganda, bureaucracy, the business of cancer, our own personal addictions to sugar and drugs, and the denial we all harbor.